Important Information Regarding Anthem Provider Contracting Disputes
- The MEA Benefits Trusts is a not-for profit employee welfare benefit plan dedicated to the health of Maine public school employees and their families.
- The MEABT contracts with Anthem to offer health insurance to approximately 68,000 active and retired educators, support staff and their dependents in the K-12 schools throughout Maine.
- Our active and retiree medical and prescription benefits are insured by Anthem.
- It is a carrier role to negotiate and contract a fair and reasonable level of reimbursement directly with provider practices as well as facilities for the services they provide.
- The contracted reimbursement rate for services provided by in-network providers to our members directly correlate to the premium rates associated with our plans and protects our members from balance billing.
- The MEA Benefits Trust had completed the renewal of our plan for the July 1, 2022 plan year and our Board of Trustees approved the renewal on March 24, 2022.
- Premium rates were released to all participating school districts on the morning of April 6, 2022.
Maine Medical Center
- Shortly after releasing the rates on April 6, the CFO of MaineHealth contacted the Trust to notify us of their intent to terminate Maine Medical Center’s provider contract effective January 1, 2023. It’s important to note that this notice to terminate was in the middle of a 3-year contract between MMC & Anthem.
- The premium rates effective July 1, 2022 were developed based on MMC being in-network and reimbursed at the negotiated contract rate.
- The MEA Benefits Trust has encouraged compromise and flexibility by both parties, to reach a resolution that is, first and foremost, in the best interests of their patients and our members.
- The MEABT continues to meet regularly with both parties to express our concerns and the importance of resolution to this contract dispute on behalf of all of our members.
- The MEABT is working with Anthem to develop contingency plans to minimize disruption to our membership in the event a resolution has not been reached.
- The MEABT has solicited input from the Bureau of Insurance in understanding the implications to our members in the event MMC becomes a non-contracted provider effective January 1, 2023.
Fore River Urology
- On May 2, the MEABT received notice that Fore River Urology would be leaving the Anthem commercial network effective August 1 and their Medicare Advantage network effective September 1.
- According to Anthem, Fore River Urology is requesting an increase in their reimbursement in excess of 50%.
- Fore River Urology has been in normal negotiations for a renewal of their participating provider agreement.
- The practice is an important part of Anthem’s provider network and we believe they should be compensated fairly for the care they give our members.
- As with all potential provider terminations, we understand that members will be concerned about continuity of care. The Trust is working Anthem on continuity of care plans for members actively being managed by providers within these practices as well as Maine Medical Center in the event that agreements aren’t reached by their associated deadlines.
- The Trust regularly goes through a Request for Information/Request for Proposal (RFI/RFP) process to evaluate carriers and make decisions on the best carrier to administer our benefits.
- The overall structure of the MEA Benefits trust is very complex and therefore the RFI/RFP process used to evaluate carriers requires a comprehensive, in-depth analysis. It is imperative when evaluating carriers that every options is fully vetted to ensure the highest level of coverage is available to our members at the best price.
- As part of our normal course of business, the MEABT will be initiating the RFP process this summer.
We recognize that the multiple provider contract disputes currently going on with Anthem have created unrest and uncertainty for our members. It is important to note, that all of these negotiations are complex and disagreements on reimbursement between providers and carriers is not unique to Anthem. The Trust expects our insurance partner to negotiate fair compensation to providers and to maintain a balance between access to quality care and cost and we continue to work with them to ensure that result.
We will continue to monitor this situation closely and as additional updates are received and as continuity of care plans and contingency plans become finalized, we will be sure to share this information.
MEA Benefits Trust